<p> NHRMA 2016 Conference & Tradeshow</p><p>September 7-9, 2016 | Bellevue, WA</p><p>ONSITE REGISTRATION FORM</p><p>PARTICIPANT INFORMATION: Please print legibly. Complete one form per person. BOTH SIDES MUST BE COMPLETED. First Name: ______Last Name:______Organization: ______Address: ______City: ______State/Province: ______Postal Code: ______Country:______Mobile: ______Email:______</p><p>EMERGENCY CONTACT INFORMATION:</p><p>Name: ______Mobile Number:______</p><p>DEMOGRAPHICS (No need to complete if you are adding to a pre-existing registration):</p><p>Please select the SHRM Chapter of which you are a member:</p><p> AK – Anchorage SHRM  OR – Portland HRMA  WA – Snohomish County  AK – Juneau-Douglas  OR – Rogue Valley  WA – South King County  AK – Mat-Su Valley  OR – Salem  WA – South Puget Sound  AK – Norther Alaska  WA – Adams and Grant HRA  WA – Southwest Washington  OR – Central Oregon  WA – Apple Valley HRA SHRM  OR – Columbia Gorge  WA – Blue Mountain  WA – Spokane/Inland Northwest  OR – Douglas County  WA – Columbia Basin  WA – West Sound HRMA  OR – Klamath Basin  WA – Lake Washington HRA  WA – Yakima Valley HRA  OR – Lane County HR  WA – Mount Baker HRA  Affiliated Student Chapter Association  WA – Olympia SHRM  Other Chapter: ______ OR – Lower Columbia HRM  WA – Seattle Chapter  I am not a SHRM Member Association  WA – Skagit Island HRMA  OR – Mid-Willamette Valley  WA – SMA Seattle</p><p>SHRM Member Number (if you do not have a SHRM member number please enter 0): ______</p><p>Please select your field, industry or area of study:  Accommodation and Food  Government, Public  Scientific and Technical Services Services Administration  Transportation and Warehousing  Agriculture, Forestry, Fisheries  Health Care, Social Services  Utilities, Energy  Arts, Entertainment and  Insurance  Waste Management, Recreation  Manufacturing Remediation  Banking, Finance  Media, Telecommunications  Wholesale Trade  Computer Technology  Mining  Other:  Construction  Professional Services ______ Defense  Real Estate, Rental and Leasing  Education  Retail Trade  What is your level of HR experience?  5-7 years  Less than 1 year  8-10 years  1-2 years  More than 10 years  3-4 years  I am not an HR Professional   PHR - CA®  Are you currently a full-time student?  SPHR®  SPHR - CA®  Yes, Undergraduate Student  GPHR®  Yes, Graduate Student  HRBP  No, Not a Full-Time Student ℠  HRMP  Which HRCI/SHRM Certifications do you hold? Please ℠  SHRM – CP select all that apply.  SHRM – SCP  PHR®  None of the above  BOTH SIDES MUST BE COMPLETED  REGISTRATION OPTIONS:  SHRM Member Full Conference Registration $675.00 = ______ Non- SHRM Member Full Conference Registration $775.00 = ______ SHRM Student Chapter Member – Full Conference $59.00 = ______ SHRM Student Chapter Faculty Advisor – Full Conference $235.00 = ______ Retiree – Full Conference $310.00 = ______ SHRM Member One Day Only (Day:______) $450.00 = ______ Non-SHRM Member One Day Only (Day:______) $525.00 = ______ Exhibit Booth Representative $140.00 = ______ Substitute $50.00 = ______ Name of original attendee: ______  ADDITIONAL ITEMS FOR PURCHASE:  Pre-Conference Workshop (Wednesday, Sept 7) $119.00 = ______ Name of Workshop: ______ Evening Event: Bowling (Thursday, Sept 8) $40.00 = ______ Guest Evening Event Ticket $40.00 = ______  TOTAL PAID = $ ______ PURCHASER INFORMATION:  Cardholder Name (As it Appears on Card): ______ Billing Address: ______ City:______State/Province: ______Postal Code ______ Type of Card: Visa MasterCard AmEx Card Number: ______ Expiration Date: ______Security Code: ______ Authorized Signature: ______</p><p> BOTH SIDES MUST BE COMPLETED AND RETURNED TO:</p><p> CONFERENCE REGISTRATION & INFORMATION DESK</p><p> MEYDENBAUER CENTER, CENTER HALL LOBBY</p><p> DURING REGISTRATION HOURS BEGINNING SEPTEMBER 7, 2016</p>